Platelet optimization in high-risk ALBI grade 3 patients undergoing invasive procedures: real-world evidence from lusutrombopag therapy.

Background: Evidence regarding lusutrombopag use in patients with hepatocellular carcinoma (HCC) and poor hepatic reserve remains limited, particularly in ALBI grade 3 patients. This study aimed to explore peri-procedural platelet outcomes after lusutrombopag treatment in HCC patients stratified by ALBI grade, with particular attention to the ALBI grade 3 subgroup. Methods: We conducted a single-center retrospective study of 76 patients with HCC and thrombocytopenia who received lusutrombopag before planned procedures. Patients were stratified as ALBI grades 1-2 or ALBI grade 3. The primary endpoint was peri-procedural platelet count, defined as the platelet on the procedure day or the closest available value within a ±2-day window. Exploratory analyses included an adjusted general linear model, logistic regression for non-response, and per-protocol sensitivity analyses excluding patients who received rescue therapy. Results: Among 76 patients, 58 had ALBI grades 1-2 and 18 had ALBI grade 3. The primary endpoint was evaluable in 60 patients, including 46 with ALBI grades 1-2 and 14 with ALBI grade 3. Median peri-procedural platelet counts were 59.0 (50.0-69.0) × 10 Conclusion: In this selected real-world HCC cohort, ALBI grade 3 was not independently associated with lower peri-procedural platelet count after lusutrombopag treatment. These findings are exploratory and should not be interpreted as evidence of equivalent efficacy or established safety across ALBI strata. Larger prospective studies are needed to validate these results.